Benjamin Lane Dickerson, PT, DPT, ATC

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

PT.015069 Issued in OH

Practice address

3207 Hilliard Rome Rd
Hilliard, OH 43026

Phone

(614) 850-0680

NPI assigned

Apr 8, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565136000000",
    "number": "1477016327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 W 6TH AVE APT 13",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432122469",
            "telephone_number": "419-618-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 HILLIARD ROME RD",
            "city": "HILLIARD",
            "state": "OH",
            "postal_code": "43026",
            "telephone_number": "614-850-0680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3207 Hilliard Rome Rd",
            "address_purpose": "LOCATION",
            "city": "Hilliard",
            "state": "OH",
            "postal_code": "43026",
            "country_code": "US",
            "telephone_number": "614-850-0680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "BENJAMIN",
        "middle_name": "LANE",
        "credential": "PT, DPT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-08",
        "last_updated": "2019-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "SC",
            "license": "8403",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "BOC154302",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "OH",
            "license": "PT.015069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Andrew Dewalt, DO
• Renee A Dewey, FNP-BC
• Kaitlin Dewilde
• Sharon Dhume, RN
• Assitan Diaby, LSW
• Jaclyn A. Dight, PAC
• Crystal Dawn Dill, COTA
• Luke Dinan, PT, DPT
• Discount Drug Mart Inc (Discount Drug Mart)
• John M Divelbiss, D.C.

• Sports Physical Therapist in Hilliard, OH
• Providers in Hilliard, OH by specialty
• Sports Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.